Tool ‘tracks’ IPC design, derogation, and risk

As healthcare designers, part of our skillset is to provide assurance that we are meeting all the requirements stipulated in guidance and legislation documents. Increasingly, we are asked to evidence the thought processes behind our design to ensure we have identified, assessed, and mitigated risk. Patient safety is inherently about not causing harm; thus proactively addressing risk in healthcare design is crucial both for positive impacts on patient care and exemplar service delivery. Successful risk management requires whole-system-thinking, along with technical knowledge insight gained from the delivery of multiple complex healthcare projects. Rarely in healthcare design is there just one simple thought, but rather a need for the intricate weaving into one technical solution of often conflicting requirements. With evidencing now required, increasingly toolkits are being utilised as a way to make this integral to the design process, and support the ‘golden threads’ of compliant decision making and the resulting information.

IPC education and upskilling work

As part of the IPC education upskilling work that HLM undertook at the end of 2023, it was identified that an improved internal design tool, which could help implement, manage, and track, IPC design, derogation, and risk, would greatly enhance our ability to positively impact on IPC measures within our designs, as well as ensuring that we had followed and left a clearly defined audit trail. Our initial thoughts around an improved tool were that it should:

• Be workable across all the RIBA stages.
• Include other disciplines to allow us to undertake our lead consultant role.
• Include items for construction works to be included within prelims, employers’ requirements, or risk assessments.
• Record design decisions.
• Be formatted to align with the 2023 revised NHS derogation schedules.
• Be supportive of, and linked to, HLM CDM risk registers, assessments, and schedules, and the practice’s CDM Design, Access, Maintenance, Adaption, and Disassembly strategy.
• Record ‘golden thread’ for risk through identification, assessment, mitigation, and management.
• Comply with HLM’s ISO 9001 Quality Management System.
• Provide an ‘instant dashboard’ to flag status.

IPC within wider standards, legislation, and requirements

ISO 9001 is an international standard that specifies
the framework for a quality management system,
allowing companies to demonstrate their ability to consistently provide services that meet customer and regulatory requirements. This encourages process-
based approaches and risk-based thinking, alongside a culture of continuous improvement and documented information.

Within ISO 9001 sits our responsibility to comply with the Construction (Design and Management) Regulations 2015. Documents such as the NHS Blue Book, covering the appointment of architects and engineers for commissions in NHS estates, are very clear about the role that design consultants play in CDM across all Business Case Stages (see supplementary annexure volume 3 — CDM Duties).

Alongside our designers’ duties under the CDM Regulations is our requirement to comply with providing input into derogation schedules. Recently updated in July 2023, a schedule of derogations must be provided by the commissioning organisation for any project requiring external business case approval. Similarly, they may be requested for projects that have gone through an organisation’s delegated internal approvals process. The data provided in externally approved business cases will be collated centrally to help inform future updates to guidance. Applicable to 100% new build, repurposing, or refurbishment, for designers, the standout requirements from the revised guidance and controls include:

• Specific criteria against which derogations should be recorded.
• Identifying derogations specifically against schedules of accommodation, in addition to capturing these again in aggregate in the full derogation schedule.
• All agreed derogations should be flagged in BIM data to manage the derogations during construction and the post-construction phases.
• Inclusion of derogations against other standards, in addition to HBNs and HTMs.
• Inclusions of derogations specifically related to the NHS Net Zero Building Standard, ICB, and other ‘green plans’.

Easily translatable to NHS schedule

The latter points, while not directly related to patient safety, do highlight the need for designers, BIM, internal schedules, and protocols, to be linkable and easily translatable to NHS schedules. Starting with HBN 00-09: Infection control in the built environment, and given the requirement to interface with other spreadsheets, our ‘in-house’ tool was developed in Microsoft Excel, and consists of several individual worksheets:

• How to Use: Guidance on how the tool works across the RIBA stages.
• Dashboards: Showing, at a glance, the number of ‘non-compliances’ against the relevant IPC standards.
• Sign-off: A tracker to ensure that relevant information is reviewed and signed off by the IPC team.
• RIBA Checklist: Relevant design team activities, alongside those of the IPC team, to ensure engagement and aligned consideration.
• General space: Requirements for the size of rooms and the space around elements.
• Waste storage: Requirements for the adequate provision of waste and associated storage.
• Ancillary space: Detailed room-by-room requirements to ensure IPC protocols within the facilities, e.g. Dirty Utilities.
• Finishes: Requirements to ensure that the correct finishes in support of IPC are specified.
• Fittings and equipment: Requirements around general fittings (excluding sanitaryware).
• Personal hygiene: Requirements around fittings specifically designed for hygienic personal use.
• Engineering: An overview of engineering-related IPC elements, to allow for architects to undertake the lead consultant role on IPC requirements.
• Construction: A works sheet to assist with advising PM/QS/contract administration teams on suitable requirements for Contractors’ Preliminaries and alignment with CDMC regulations.

Schedules of non-compliance created

Designed to ask questions with ‘yes’ answers for compliance, the spreadsheet siphons off data to collate schedules of non-compliance, which can then be easily input into NHS Derogation or CDM risk registers and assessments. The headlines from all the sheets also input into an overall ‘dashboard’, which gives at-a-glance risk and derogation profiling using simple RAG (Red Amber Green) colouring.

While the current tool has been written around HBN 00-09, in support of HLM’s work north of the border, the tool will be extended to cover the HAI-SCRIBE and KSAR processes for NHS Scotland. IPC issues in Scottish hospitals have been well documented in recent headlines, and with growing awareness and scrutiny around the spread of infections post-COVID, HLM is well placed to ensure the continued competence of its designs.